Provider Demographics
NPI:1740398015
Name:CORBIN CARDIOLOGY & INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:CORBIN CARDIOLOGY & INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-528-5331
Mailing Address - Street 1:15 MOONBOW PLZ
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:412 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1137
Practice Address - Country:US
Practice Address - Phone:606-539-9898
Practice Address - Fax:606-539-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3029Medicare ID - Type UnspecifiedGROUP NUMBER